CAJ | 학술논문

目的探讨超声刀无钛夹法腹腔镜胆囊切除术(UHS-LC)胆管损伤的特点、处理方法及预防措施.方法回顾性分析近5年行UHS-LC1863例的临床资料,11例发生胆管损伤,全部经手术修复,随访1～5年.结果 11例胆管损伤分别为:右肝管损伤3例,肝总管损伤2例,胆总管横断3例,胆总管穿孔2例,胆总管横断合并左、右肝管同时损伤1例;损伤于手术中发现9例,手术后发现2例.11例患者共施行再手术13次,无胆管狭窄,无死亡病例.结论手术时一定要弄清肝总管、胆总管与胆囊管三者的关系,采用顺逆相结合的方法,遵循"辨-切-辨"原则,腹腔镜下打结技术对术者要求较高,尤其是三孔法LC,过分牵拉Calot三角易造成出血和副损伤,在靠近胆总管的地方尽量使超声刀刀头的背面朝上,并且其背面绝对不能直接接触胆总管,术中及术后早期发现胆管损伤者,应即刻妥善处理.
목적 탐토초성도무태협법복강경담낭절제술(UHS-LC)담관손상적특점、처리방법급예방조시.방법 회고성분석근5년행UHS-LC1863례적림상자료,11례발생담관손상,전부경수술수복,수방1～5년.결과 11례담관손상분별위:우간관손상3례,간총관손상2례,담총관횡단3례,담총관천공2례,담총관횡단합병좌、우간관동시손상1례;손상우수술중발현9례,수술후발현2례.11례환자공시행재수술13차,무담관협착,무사망병례.결론 수술시일정요롱청간총관、담총관여담낭관삼자적관계,채용순역상결합적방법,준순"변-절-변"원칙,복강경하타결기술대술자요구교고,우기시삼공법LC,과분견랍Calot삼각역조성출혈화부손상,재고근담총관적지방진량사초성도도두적배면조상,병차기배면절대불능직접접촉담총관,술중급술후조기발현담관손상자,응즉각타선처리.
Objective To investigate the clinical features and management of bile duct injury caused by laparoscopic cholecysteetomy by using harmonic scalpel (UHS-LC), and its prevention. Methods The clinical data of 1863 UHS-LC cases from April 2003 to February 2008 were retrospectively analyzed. There were 11 patients suffering from UHS-LC related iatrogenic bile duct injury including intraoperatively immediate recognized injuries in 9 cases, and postoperatively found injuries in 2 cases. For those patients in which bile duct injury was found during the UHS-LC procedure, the patient was converted to open surgery, the injury was repaired accordingly by end-to-end bile duet anastomosis or Roux-en-Y procedure. For the injuries found postoperatively (all two cases were of CBD perforation), CBD was sutured by second stage. Results All the 11 patients recovered well and no biliary stricture occurred during the follow up of 1-5 years. Conclusions While UHS-LC is suitable for most cases of choleeystectomy, it causes significant porcentage of bile duct injury (0. 6% ) in hands of unskillful surgeons. It is important to be on alert against iatrugenic bile duct injuries.